Discover the items that insurance carriers consider Durable Medical Equipment (DME) and why that matters to your billing practices. Hint, some may surprise you! But, all have one requirement in common.
When you think of DME items to rent or purchase, sleep aids may be the last thing on your mind. However, to those who struggle to get a good's nights rest for medical reasons, such as ongoing pressure point pain, bedsores, and sleep apnea, the right DME item could mean the difference between waking up to pain or breathing difficulties and feeling rested and refreshed. Examples of equipment that are deemed billable in this category include such items as pressure reducing beds, hospital beds, mattresses, and mattress overlays along with Continuous Positive Airway Pressure (CPAP) devices and their accessories. If a patient is in need of one of these devices, check with your patient's insurance to see which items are available for coverage in accordance with the patient's healthcare plan and medical diagnosis.
Other items that are used to help regulate one's health issues such as blood sugar (glucose) monitors and test strips are also considered billable. These devices and tests are essential to ensuring one's glucose levels are in the normal range in case a lifestyle or medication adjustment is needed. Without knowing how much glucose your patient's body is absorbing, there can be dangerous consequences for too much glucose resulting in damage to the eyes, kidney, nerves, heart and more. In addition to eating well, exercising, and taking prescribed medications, insurance carriers understand blood sugar monitors and test strips play a crucial role in avoiding the more serious effects of unbalanced glucose levels.
For blood pressure monitors, on the other hand, there are some restrictions. Insurance will cover certain devices for receiving hemodialysis or peritoneal dialysis and monitoring frequently noted low or high blood pressure while at home. However, it is important to learn the limitations of coverage for each carrier as many devices and uses are often deemed to be experimental and your claim may be denied.
Patients requiring assistance at home with walking, standing, sitting, or other mobility-related activity may be covered for the following items after a physician has deemed the equipment to be necessary:
- Walking Canes (other than white canes for the blind)
- Manual Wheelchairs
- Power Wheelchairs
- Power Scooters
- Patient Lifts
Since incontinence problem that affects millions of individuals in the U.S. alone, patients with severe cases may be prescribed a commode chair. These chairs are also suggested for patients who are considered to have a high fall risk. Should the patient require a commode chair to be used in the home to prevent accidents while trying to get to the bathroom, such items are considered billable DME.
Physical Therapy Devices
Injured patients may need temporary therapy devices such as a Continuous Passive Motion (CPM) machine or traction equipment. These devices can be extremely important to a patient's recovery. As such, the equipment is often covered with restrictions. Since many therapeutic devices are considered to be experimental by insurance carriers, it is helpful to learn which pieces of equipment are covered by each individual carrier.
Home Medical Care
Of course, ongoing at-home care can include specific devices that administer certain medications, enhance breathing, or remove fluids. Refer to the criteria and list of covered items for the patient's insurance carrier for details about which items may be reimbursed and for what purposes. Equipment typically covered for this level of care may include:
- Infusion Pumps and Supplies
- Nebulizers and Nebulizer Medications
- Oxygen Equipment and Accessories
- Suction Pumps
Thus, most of the above DME items will qualify for coverage without fear of a denied claim with the proper documentation. However, there is one requirement all DME items have in common, the patient must have a prescription stating the equipment has been determined to be necessary for the patient's quality of life by a licensed physician. If you would like to utilize our consulting, coding, AR management, auditing, or other billing-related services to ensure you have correct claim codes and submission requirements met for a smoother billing process, contact us using our online form or call us at (678) 273-3404. Our expert billing team specializes in DME and HME coding and has experience working with all major insurance carriers' guidelines and policies. By working with us, you can rest easy knowing your DME and HME billing is in good hands for the most accurate submissions and fastest payments available.